Yolanda Orosco-Arellano decided she would get the coronavirus vaccine long before it became available. But securing an appointment for it was less straightforward.
The hotel housekeeper and mother of four worried about her anemia, a risk factor for severe illness from the virus. But Orosco-Arellano doesn’t have a car and needed a vaccination slot scheduled around her shifts at the hotel.
Barriers to getting the shot and information about the vaccines have hindered the “unvaccinated but willing,” who account for approximately 10 percent of the American population, according to a report last month by the Department of Health and Human Services. Unlike those who have declined vaccines, some vocally, because of their politics or ideology, a quieter share – about 44% of unvaccinated people – say they would get vaccinated but are on the fence for certain reasons. Some, like Orosco-Arellano, lack transportation or other means, while others wish to wait and see or don’t know coronavirus vaccines are free.
Immunizing that population could be critical to attaining herd immunity and protecting those disproportionately affected by the pandemic. But public health officials have, so far, struggled to reach young adults, Blacks, Hispanics and uninsured people, groups who are unvaccinated but willing at higher rates.
To fill the gap, a motley contingent of volunteers has stepped in – from nurses ferrying patients in their own cars to retired health care workers manning phone lines to community members passing out educational fliers. Nearly 100 free and charitable clinics across the country, which offer services to uninsured or underinsured people, have forged bridges with underserved communities in an initiative dubbed “Project Finish Line,” aiming to vaccinate 1 million hard-to-reach people like Orosco-Arellano.
Her clinic, HealthNet in Rock County, Wis., is one of the ones adapting to reach the unvaccinated but willing and has offered rides to patients and expanded their hours around work schedules. Orosco-Arellano got her shot in May at the clinic.
“I felt comfortable here,” she said in Spanish, sitting in the clinic beside the caseworker, Alicia Alvarado, who drove her to the appointment and translated for her.
The initiative by clinics has immunized more than 112,000 people since June said Joe Agoada, the CEO of Sostento, a nonprofit that supports front line health workers in underserved communities and launched the project. HHS noted in the report last month that the percentage of people who were unable but willing to get vaccinated has declined, indicating the outreach has had some success.
But the effort has hinged on safety-net clinics like HealthNet that have become a bedrock in their communities but do not receive federal funding, Agoada said. The clinics’ patients include those experiencing homelessness or those who are unable to get health insurance. Before the pandemic hit, the clinics offered vital health care to 2 million people who needed it.
“They’re overburdened by the number of patients, and their patients themselves are burdened,” Agoada said.
Sostento has raised $500,000 for the vaccination initiative, half of what the nonprofit says is needed.
“Free and charitable clinics are vaccinating populations nobody else can, despite a lack of resources,” Agoada said. “To defeat this pandemic, we cannot afford to overlook and underinvest in this group, and yet so far this is exactly what has happened.”
The clinics depend on grants and donations and, during the pandemic, thousands of volunteer hours, many at the front lines of the vaccination effort.
At HealthNet in Wisconsin, in addition to clinic staff driving patients to their appointments, some have spent their lunches or off-hours vaccinating people who can’t visit while the clinic is open. Even the clinic’s CEO, Ian Hodge, has passed out his cell number, responding to texts on weekends to sign people up for appointments.
“That was VIP red carpet service,” he said. “I would have never done that for anyone else except for individuals who felt that no one else was listening or talking to them.”
The clinic has also brought on two “ambassadors” to educate their neighbors between jobs and classes. For Jovany Ochoa, this volunteer gig has been a chance to convince his former co-workers to get vaccinated.
Ochoa, 23, grew up in the area’s Mexican immigrant community and hopes to become a physician assistant. He got his first job in middle school at a construction company to help make ends meet at home. He later worked at a tobacco farm. Now, Ochoa, a college graduate, recalls how most of his former co-workers, at risk of serious injury on the job, didn’t have health insurance.
“I saw these individuals weren’t getting the care that they needed,” he said. “I think my love of health care came from that.”
Armed with a handful of brochures, Ochoa drives to places where he thinks he can talk to people about the vaccine, like the Mexican supermarket his mother shopped at and farms and factories where he knows many workers remain unvaccinated.
Sometimes managers or employers tell him to leave. Often, the limited time he’s allotted during lunch breaks drags on as workers pepper Ochoa with their questions about the vaccines. Without this chance to talk to Ochoa, the workers would have little opportunity to seek out information on their own, he said.
“They were pretty simple questions,” Ochoa said. “How they could get it, what they needed, if it was true they needed a social security number.”
Many undocumented immigrants, despite being eligible for the vaccine, fear needing official identification to receive it – although showing a driver’s license, Social Security number or health insurance card is not mandated.
Ochoa said it was unfair people he has talked to have been lumped in with those who refuse to get the vaccine because they are against it. He said their reasoning is far from political.
“It isn’t fair because there’s a lot more to it than that,” he said. “I just don’t want them to be categorized for being selfish or anything like that because that’s not the reason they’re not getting it. They’re not getting it because sometimes they literally can’t or they don’t know how to.”
The reasons people have not yet gotten their shot vary widely, making it difficult to find a one-size-fits-all approach.
Medical Outreach Ministries, a clinic in Montgomery, Ala., surveyed its patients, who are mostly Black and middle-aged, to learn about their thoughts about the vaccines. While clinic staff had thought the nation’s history of medical racism and victimization would play a large role in hesitancy, they learned it was much more complicated.
“You assume people are hesitant because of the Tuskegee syphilis study or something like that but they have their other reasons,” said Molly Stone, the clinic’s executive director. “And that’s something that we all had to learn.”
Volunteers, including pre-med student Cody Grier, found that patients were overwhelmed by information available online and preferred speaking to health workers about the vaccine by phone. Then, he found out through surveys and calls that patients had questions that people with better access to doctors would be able to ask at their appointments.
“Before I started giving out the survey, I thought that hesitancy was maybe more of an abstract thing,” Grier said. “I thought it was more general distrust. There is that, but it’s more grounded too. They want it straight.”
Grier recalled some frequently asked questions: How is it going to affect me? What are the side effects? How will it interact with the drugs I already take?
After finding some believed the vaccine might cost money, the clinic shared that getting a shot is free and watched that concern diminish in subsequent polling.
Despite the progress made to vaccinate the scores of people willing to get their shot, many of the volunteers expressed fears that these inequities that have persisted long before the pandemic won’t simply go away after herd immunity is reached or the pandemic wanes.
Born and raised in segregated Milwaukee, Ericka Sinclair, the CEO of Health Connections clinic, has seen these gaps for her whole career. Sinclair decided to create the clinic six years ago to help bridge them. Before the vaccine became available, Sinclair expected her patients, many of them HIV-positive, transgender and Black, would have questions they struggle to find answers for.
“I always knew that it was going to be an issue,” she said. “It’s always been an issue.”
Sinclair, who formerly worked at the Centers for Disease Control and Prevention in infectious-disease and emergency management, said the country lacks critical funding needed to support clinics like her own, furthering distrust at the worst time possible. The nation’s top decision-makers are not the same as the people on the ground, Sinclair said, leaving people like her to figure out how to straddle the schism.
For instance, when the state touted a $100 incentive to get immunized, Sinclair learned about the decision from watching the announcement on television. She scrambled to quickly address patients’ inquiries about a program she just learned about.
“If you leave too much of a gap between when the question is asked and when there’s an answer, that creates distrust every moment that exists,” she said. “People need to feel addressed, not dismissed.”